MEDICARE: FITNESS FORUM LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist

General Provider Information

NPI Number	:	1841252293
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FITNESS FORUM LLC

Provider Business Mailing Address
First Line	:	322 E CENTER ST
Second Line	:
City	:	WEST BRIDGEWATER
State	:	MA
Zip	:	02379-1824
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	322 E CENTER ST
Second Line	:
City	:	WEST BRIDGEWATER
State	:	MA
Zip	:	02379-1824
Country	:	US
Telephone Number	:	508-559-5070
Fax Number	:	508-559-5072

Authorized Official
Title or Position	:	CEO
Name	:	MR. JAMES SMITH
Credential	:
Telephone Number	:	315-477-0888

Provider Enumeration Date	:	04/03/2006
Last Update Date	:	08/22/2020

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